Authorization Form - Sandhill Charters

Authorization for the Burial at Sea by the Scattering of Ashes by Sandhill Charters LLC

Please fill out the following form in order to authorize Sandhill Charters LLC to perform Sea Scattering services

Date of Authorization(Required)

First Name(Required)

Last Name(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I/We the undersigned hereby request and authorize" Sandhill Charters LLC . (hereby referred to as the "Company") to take possession of and make arrangements for, the dissemination of the cremated remains,(hereafter referred to as the "Deceased") in accordance with and subject to: a) the terms and conditions set forth in this authorization; b) the Company's Rules and regulations; and c) any applicable federal, state, or local laws and regulations.

Initials(Required)

I/We certify, warrant and represent that I/We have the full legal right and authority to authorize the dissemination of the remains of the deceased. I/We hereby authorize the Company to disseminate the cremated remains of the Deceased at sea in the offshore waters of the State of Florida. I/We hereby direct the Company to disseminate said cremated remains at sea, in accordance with State and Federal Law.

Initials(Required)

"Burial at Sea" or "Ash Scattering" consists of the scattering of cremated remains at sea. I understand that once the cremated remains of the Deceased are scattered, they are unrecoverable. Unless otherwise specifically provided for herein, once scattering of cremated remains of the Deceased has been performed, the Company will dispose of the container which contained said cremated remains. The obligation of the Company shall be limited to the disposition of the cremated remains as directed herein. I agree to release and hold harmless the Company, its affiliates and their agents, their employees & contractors, successors and assigns from any and all loss, damage, liability or causes of action (including attorney's fees and expenses of litigation) in connection with the disposition of the cremated remains of the Deceased as authorized herein or respect to the identification of said cremated remains as being those of the Deceased.

Initials(Required)

Special Instructions, Requests or Notes

Which Service Are You Requesting?(Required)

Select One Option

Attended Ash Scattering

Unattended Ash Scattering

How Many People Will Be On The Boat?(Required)

Use Dropdown Menu To Select

How Will Cremains Be Provided To Sandhill Charters(Required)

Select One Option

Family Will Bring At Time Of Service

Mailed Using USPS Cremains Kit #2

Request Local Pickup (Palm Beach County Only)

Enter Address Where Cremains Are To Be Picked Up

Street Address Address Line 2 City State ZIP Code

Name of Deceased(Required)

Relationship to Deceased(Required)

By selecting the “I agree” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting “I agree” using any device, means, or action, I consent to the legally binding terms and conditions of this document. I further agree that my signature on this document is as valid as if I signed the document in writing. I am also confirming that I am authorized to enter into this Agreement. If I am signing this document on behalf of a minor, I represent and warrant that I am the minor’s parent or legal guardian. I may decline to electronically sign this document and withdraw my consent to sign this document electronically by contacting the signature requestor directly, which may delay transactions. I may contact the signature requestor separately to request to sign this document on paper or to receive a paper copy of the signed document. Any fees for such paper copy will be charged then by the signature requestor.

I declare that the info I've provided is accurate & complete

I agree to the terms & conditions

Print Name(Required)

Your Signature(Required)

Authorization for the Burial at Sea by the Scattering of Ashes by Sandhill Charters LLC

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